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Mental Health Review

I think it’s beyond time to review the Victoria Mental Health Act (1986)*. The way the system treats those with mental illnesses is horrifying, and the other day this was brought home to me again as I chatted to a woman I know and her very recent experience with the Mental Health Act and the whole medical/police system. I’m going to summarise her story, and leave out anything that will identify her. That said, I don’t know every step of her story, I know what she told me the other night, and that in itself is horrifying without knowing all the rest of the story.

A little bit over a week ago, someone I know (and for the sake of this story I will call her Brenda) attempted suicide via ODing on the drugs that she is prescribed. The next day the police kicked her door in (I’m guessing she called triple zero and asked for assistance) and during offering their “assistance” several police crash tackled her to the floor and she had capsicum spray, sprayed in her face. She was handcuffed (very tightly) and forced to lie on her handcuffs in the ambulance where she was taken to hospital. Once there she was told she was to have a blood test, which she refused. This resulted in several guards holding her down and strapping her to the table and her blood being forcibly taken. Unsurprisingly, this brought gave her rape flashbacks and deeply traumatised her.

Eventually from emergency she was transferred to the psych unit of the hospital, where she was given very little information about her stay, where she could shower, and she was barely fed during her ordeal. She was there for 6 days and told me that she’d been fed three meals, and that it had taken them three days to tell her where she could shower. The hospital provided her brother with more information than they provided to her.

Eventually Brenda found out that she’d been detained under Section 10 of the Mental Health Act (1986):

Apprehension of mentally ill persons in certain circumstances
10. Apprehension of mentally ill persons in certain circumstances
(1) A member of the police force may apprehend a person who appears to be
mentally ill if the member of the police force has reasonable grounds for
believing that-
(a) the person has recently attempted suicide or attempted to cause
serious bodily harm to herself or himself or to some other person; or
(b) the person is likely by act or neglect to attempt suicide or to cause
serious bodily harm to herself or himself or to some other person.
(1A) A member of the police force is not required for the purposes of
subsection (1) to exercise any clinical judgment as to whether a person is
mentally ill but may exercise the powers conferred by this section if, having
regard to the behaviour and appearance of the person, the person appears to
the member of the police force to be mentally ill.
(2) For the purpose of apprehending a person under subsection (1) a member of
the police force may with such assistance as is required-
(a) enter any premises; and
(b) use such force as may be reasonably necessary.
(3) A member of the police force exercising the powers conferred by this
section may be accompanied by a registered medical practitioner or a mental
health practitioner.
(4) A member of the police force must, as soon as practicable after
apprehending a person under subsection (1), arrange for-
(a) an examination of the person by a registered medical practitioner; or
(b) an assessment of the person by a mental health practitioner.
(5) The mental health practitioner may assess the person, having regard to the
criteria in section 8(1) and-
(a) advise the member of the police force to-
(i) arrange for an examination of the person by a registered medical
practitioner; or
(ii) release the person from apprehension under this section; or
(b) complete an authority to transport the person to an approved mental
health service in accordance with section 9A(1).
(6) If the mental health practitioner assesses the person and advises the
member of the police force to arrange for an examination of the person by a
registered medical practitioner the member of the police force must do so as
soon as practicable.
(7) If the mental health practitioner assesses the person and advises the
member of the police force to release the person from apprehension under this
section the member must do so unless the member arranges for a personal
examination of the person by a registered medical practitioner.
(8) If an arrangement is made under this section to have a person examined by
a registered medical practitioner, a registered medical practitioner may
examine the person for the purposes of section 9.
(9) Nothing in this section limits-
(a) any other powers of a registered medical practitioner or mental health
practitioner in relation to that person under this Act; or
(b) any other powers of a member of the police force in relation to that
person.

and hospitalised under Section 8 of the same Act:

Criteria for involuntary treatment
8. Criteria for involuntary treatment
(1) The criteria for the involuntary treatment of a person under this Act are
that-
(a) the person appears to be mentally ill; and
(b) the person's mental illness requires immediate treatment and that
treatment can be obtained by the person being subject to an
involuntary treatment order; and
(c) because of the person's mental illness, involuntary treatment of the
person is necessary for his or her health or safety (whether to
prevent a deterioration in the person's physical or mental condition
or otherwise) or for the protection of members of the public; and
(d) the person has refused or is unable to consent to the necessary
treatment for the mental illness; and
(e) the person cannot receive adequate treatment for the mental illness in
a manner less restrictive of his or her freedom of decision and
action.
Note In considering whether a person has refused or is unable to consent to
treatment, see section 3A.
(1A) Subject to subsection (2), a person is mentally ill if he or she has a
mental illness, being a medical condition that is characterised by a
significant disturbance of thought, mood, perception or memory.

(There is a subsection 2 of this section of the Act, but it isn’t relevant for this blog post).

So it’s a nice twisted road – the police can arrest you for attempting, or them believing that you may attempt, suicide, and then if you refuse to be treated, you will be involuntarily committed and kept against your will. Another friend of mine recently voluntarily admitted himself to a hospital for treatment, and then was told when he considered leaving that if he did he’d be involuntarily committed and not allowed to leave if he attempted to leave at that point.

I also think that’s it’s a REALLY bad idea to allow the police to use “force as may be reasonably necessary” in dealing with any person with mental illness/es. It’s turned out reallybadsofar, with a large number of people with mental illnesses being shot by police, and I’m sure that those people who are traumatised by authority figures are additionally traumatised by the police using force against them when they’re at their lowest point.

There really has to be a better way of treating people with mental illnesses, and I’d start by treating them as people who are aware of their conditions, or who may need information and diagnosis about their conditions (someone who is undiagnosed wouldn’t be educated about their condition clearly). To make the any treatment options an informed decision of the individual who is likely to receive it. To work with the individual and not against them. To listen to their fears, concerns, needs and work through and with those. Proper partnered care has to be a better option than forced care, in the long term.

The upshot of Brenda’s experience is that she’s more traumatised than before she was admitted to hospital, she was released with no support networks in place (she lied to get out of hospital because that environment was adding to her trauma), she doesn’t feel heard by her friends of family, and she wants care but on her terms and not through force.

Charities such as SANE which try to reduce the stigma of mental illness are let down by the legislation governing mental health, which clearly treats mental illness differently than any other public health issue. When governments treat one group of citizens differently because of a real or perceived difference, then everyone else will treat them differently. To improve the situation of people with mental illnesses, they have to be treated the same way everyone else is. Not everyone with cancer wants chemotherapy, and not everyone with mental illness wants to take medication to treat it. If someone is educated about their health condition, they can make an educated decision about the treatment they wish to receive to deal with it. And surely, if they are not likely to harm someone else, their choices should be respected.

I’m not a mental health expert, and cannot comment authoritatively on mental health, but I am certainly looking at it and from where I’m sitting right now, it sucks.

If you are in Australia, you might also want to call:
Lifeline Australia at telephone: 13 11 14

* I think it’s really telling that the date of this Act is over 20 years ago – which indicates that the legislation has not been significantly revised since that date – either to address changes in treatment options of people with mental illnesses or to address the human rights of people with mental illnesses.

6 thoughts on “Mental Health Review”

Reading this has absolutely horrified me. I can’t imagine the level of fear this ordeal induced in Brenda and countless other people who have experienced similar “help” in the past 25 years since that act was introduced!

I came to this searching for some help for a friend of mine who’s relative attempted suicide in Victoria.
In this case I feel the reverse applies as this person was admitted in the coma after OD to end problems at home, with one adult child drug addicted and causing havoc in the family having almost split the parents .
When this person came around, I believe after taking a large amount of Valium, this person was sent back home in what could be perceived at this stage a very dysfunctional environment.
I understand this person is very angry and not responding to anyone who could provide care.
Perhaps you’d imagine in this case some order would have been required and with need of enforcement if justified. Instead we have to rely on one practitioner’s opinion associated with mental health or general health!
I have witnessed such incident when a psychiatrist sent a person back home after having slashed one’s wrist on the middle of the night and getting a phone call within the same hour from the local hospital who had received again that same person with the other wrist slashed!
I understand excess of force or even having some one brought to an institution for involuntary care is drastic, but picking up a dead body can be even more drastic!
In my present case I have great difficulty to understand how a person in such a state can be sent home within less than 24 hours in an environment which is precisely the one that brought this tragic situation.
This is not to condone any undue brutality or systematic “incarceration” But there is a duty of care to protect desperate people.
It’s never very pretty to oblige someone to follow a course of action against one’s will but there are situation where unpopular measure need to be taken for the greatest good. MB

The moral discussion of whether suicide is something that should be prevented or not is a tricky one. Clearly in a perfect society, help would be available for those who found that they were not able to cope, for whatever reason, at next to no cost, and a long time before people were suicidal. Sadly, we’re not living in that society. And although the (often unexpected) death of someone at their own hand is difficult to deal with, I do wonder if when we prevent people from suiciding whether we’re genuinely helping them – especially as our mental health system in Australia is rather fucked.

My point in this article is that we treat people with mental health issues as less than full citizens. After all there is an entire act which dictates how they are to be treated, including locking them up with no arrest and crime, if doctors and the police think that is the best option, which is something that is unlikely to happen to me – someone without a mental illness. How is that fair?

If mental health was appropriately funded, the resources were made available for those who needed them and there was no stigma attached with having a mental illness (just like there is no stigma attached to having the flu, or appendicitis), then I’d never have needed to write this article in the first place. Wouldn’t it be great if as a society we actually funded medicine properly so that the safety net caught everyone, not just most of us.

As the person this involved in this event that is not where it ended. It gets even more fucked up when a few months later I was charged with 2 accounts of assault of a police officer for my struggles during the ordeal and dragged though the court system – my only crime was being mentally unwell.

I like to think society has come a little way regarding mental health, i know my own personal view has altered drastically especially in the last 6-8 years. i think as the intial few have step out as said hey i have this problem, instead of hiding it , has led to a larger number of people letting people know they have a problem, and the tolerance of society has turned a corner on this matter, its got a ways to go, i think the mental health system has to catch up myself.
speaking for myself, with knowing people and actually educating myself, my tolerance and compassion towards people with mental disorders has grow to a point where i care and i am willing to help, i hope others in public and in business like myself can come to this level.

I found this blog because I typed in a cathartic web search using the term: “mental health services in Australia are f****d.”

I did this out of frustration and disillusionment at the treatment of mental illness in the public health system where I work.

The story you relate could be any one of my patients on any given day. Being a non-psychiatric clinician “treating” patients with acute psychosocial distress that leads to overdose or other self-harm means being a frustrated onlooker to the spectacle of an under-resourced, over-strained, poorly-conceived and poorly-organised mishmash of inpatient and community mental health services that seems to harm more than it helps – at least, that’s what I see.

Maybe it works for some people, but I don’t see them. I don’t see how.